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Individual

CHARLES DAVIS MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP-C

Contact information

Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-0211
Mailing address
1825 HONEYSUCKLE WAY, GROVETOWN, GA 30813-3171
(706) 589-1355

Taxonomy

Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
RN250185
GA
363LF0000X
Family Nurse Practitioner
Primary
RN250185
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
W274616956
AETNA
Enumeration date
11/01/2022
Last updated
07/05/2023
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